Patient Presentation
A 9-month-old male came to clinic because of fussiness and fever for 2 days. The infant had had runny nose and a mild cough for 5 days. Two days previously he started to have fever up to 102.3F and was very fussy. He often would pull on his left ear. His mother took a less medical interventional approach and had been giving him plenty of fluids, warm baths etc. but no antipyretic medication. The past medical history was non-contributory.

The pertinent physical exam showed a fussy infant with a temperature of 100.9F, respiratory rate of ~30 but was crying,and heart rate of 116 beats/minute. Capillary refill was brisk and he had moist mucous membranes. HEENT showed copious clear rhinorrhea, normal throat, and a left ear that was red, and bulging with purulent fluid behind it. The right tympanic membrane was slightly dull and slightly pink but had normal landmarks and no obvious fluid. His lungs were clear and the rest of his examination was normal.

The diagnosis of a left acute suppurative otitis media was made. The mother took some convincing that this should be treated with antibiotics, as she wanted to treat with herbal tea like her mother and grandmother had used, and had read that garlic could be used to treat ear infections. The pediatrician discussed with the mother the reasons why he was recommending using antibiotics, and the potential risks of not using them including perforation, mastoiditis or other intracranial infections. He also gently discussed that teas and garlic could have their own potential side effects. “You are doing a very good job breastfeeding and keeping him hydrated. I understand that you read about garlic being used but many of the studies have problems with them, and also may only be effective with certain people. The studies for complimentary treatments usually don’t include children,” he explained. The mother after more time, agreed that she would give the antibiotic, and may even try 1-2 doses of an antipyretic. At followup 6 weeks later the mother reported that he had finished the antibiotic, but she had not given the antipyretic, tea or garlic and he improved about 2 days after starting the antibiotic.

Discussion
Garlic, Allium sativum, is an aromatic edible bulb of the Liliacae family. It is a perennial plant and is used in cooking and also as a medicinal plant in many cultures. Other alliums include onions, chives, leeks and shallots. There is no odor when the bulb is intact, but once cut or crushed there is a pungent smell of the allicin molecule that is sulfur-containing. It is used fresh, as a powder or oil in foods/medicines and is sometimes applied to the skin.

Potential positive effects:

• Cardiovascular
  • Lowering cholesterol – evidence is conflicting. A study in children did not find any changes in any of the major cholesterol/lipid levels after taking garlic for 3 times a day for 8 weeks. There was a small change (10%) for apoprotein A-I level.
  • Lowering blood pressure – evidence is limited in adults but may be helpful. Data for children is minimal.
  • Decreasing platelet aggregation – evidence is limited in adults but may be helpful. Data for children is minimal.
  • Cancer risk
    • Garlic itself is not associated with reduced risk of gastric cancer, but there may be a link between increased dietary intake from the Allium family and decreased cancers especially gastrointestinal cancers based on epidemiological studies.

  Known side effects:

  • Pungent breath and body odor
  • Nausea/dyspepsia
  • Allergic reactions
  • Skin irritant and burns (especially if used crushed/cut bulb is used under occlusion) – raw garlic should not be used on any skin surface because of the risk of irritation/burn
  • Drug interference – can possible potentiate the drugs effects (i.e. increase the risk for bleeding in those taking an anticoagulant), or mitigate other drugs effectiveness

Learning Point

Infection

• Viruses/common cold – there is not enough evidence to show efficacy but garlic is commonly used by some populations to treat the common cold. One pediatric study using garlic tablets with a parasiticide was reported to decrease morbidity for acute respiratory disease, but there were several concerns with the study.
• Acute otitis media – one pediatric study using herbal drops (garlic was one of 4 herbs in the drops) did not find any difference in pain between intervention and control.
• Gastrointestinal parasites – one study claimed that garlic infusions for 3 different parasites was safe and shortened treatment duration but no statistical analysis was provided to support the claim.
• Warts – one study using 1/2 clove of garlic applied with a bandage overnight reported resolution with ~3 weeks and up to 12 weeks of usage. This was a small study of only 5 individuals. This has risks; see the known side effects above.

It is possible to hypothesize why garlic was/is used for some infections. Is the noxious breath or body odor enough to keep other people away and therefore decrease contact and prevent the spread of cold viruses? Could the garlic’s irritant side effect be used to treat warts similar to how other blistering agents such as cantharone are used? Again, note that garlic is not recommended for these problems.

Questions for Further Discussion
1. What types of herbal medicine or integrative medicine practices do you encounter in your practice?
2. How do you acknowledge and respect parental autonomy and beliefs while also balancing scientific knowledge and practice?
3. What resources do you use to gain more information about complementary and integrative health?

Related Cases

Disease: Ear Infections | Herbal Medicine

Symptom/Presentation: Ear Pain

Specialty: General Pediatrics | Pharmacology / Toxicology

Age: Infant

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Herbal Medicine.
To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Shamseer L, Charrois TL. Complementary, Holistic, and Integrative Medicine: Garlic. Pediatrics in Review. 2006;27(12)e77-80.

Rafaat M, Leung AKC. Garlic Burns. Pediatric Dermatology. 2000;17(6):475-476. doi:10.1046/j.1525-1470.2000.0182

Garlic. NCCIH. Updated 2020. Accessed May 28, 2024. https://www.nccih.nih.gov/health/garlic

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa